| NPI | 1033556303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 12098-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA cw017241) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2023-05-17 |